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 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:

Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.

The initiation of treatment with a cytotoxic medicine must be by an experienced and specifically trained prescriber. This would normally be a Consultant but may be a non consultant specialist grade or ST doctor under supervision.

All prescribers may continue agreed treatments but they must have received generic training in the use of cytotoxics, specific training in relation to the actual medicine prescribed and be a Consultant or under the supervision of a Consultant.

FY1 and FY2 doctors are not allowed to prescribe intravenous cytotoxics but can assess patients as medically fit to receive them.

Chapter Links...
 Details...
08.01  Expand sub section  Cytotoxic drugs
08.01  Expand sub section  Side-effects of cytotoxic drugs
08.01  Expand sub section  Drugs for cytotoxic-induced side-effects
08.01.01  Expand sub section  Alkylating drugs
08.01.02  Expand sub section  Anthracyclines and other cytotoxic antibiotics to top
08.01.03  Expand sub section  Antimetabolites
08.01.04  Expand sub section  Vinca alkaloids and etoposide
08.01.05  Expand sub section  Other antineoplastic drugs
08.01.05  Expand sub section  Amsacrine
08.01.05  Expand sub section  Arsenic trioxide to top
08.01.05  Expand sub section  Bevacizumab
08.01.05  Expand sub section  Bexarotene
08.01.05  Expand sub section  Bortezomib
08.01.05  Expand sub section  Brentuximab vedotin
08.01.05  Expand sub section  Cetuximab to top
08.01.05  Expand sub section  Crisantaspase
08.01.05  Expand sub section  Dacarbazine and Temozolomide
08.01.05  Expand sub section  Erlotinib
08.01.05  Expand sub section  Hydroxycarbamide
08.01.05  Expand sub section  Imatinab to top
08.01.05  Expand sub section  Mitotane
08.01.05  Expand sub section  Panitumumab
08.01.05  Expand sub section  Pentostatin
08.01.05  Expand sub section  Platinum compounds
08.01.05  Expand sub section  Porfimer sodium and temoporfin to top
08.01.05  Expand sub section  Procarbazine
08.01.05  Expand sub section  Protein kinase inhibitors
08.01.05  Expand sub section  Tezanes
08.01.05  Expand sub section  Topoisimerase I inhibitors
08.01.05  Expand sub section  Trabectedin to top
08.01.05  Expand sub section  Trastuzumab
08.01.05  Expand sub section  Tretinoin
08.01.05  Expand sub section  Vismodegib
08.02  Expand sub section  Drugs affecting the immune response
08.02  Expand sub section  Immunosuppressant therapy to top
08.02.01  Expand sub section  Antiproliferative immunosuppressants
08.02.02  Expand sub section  Corticosteroids and other immunosuppressants
08.02.03  Expand sub section  Anti-lymphocyte monoclonal antibodies
08.02.04  Expand sub section  Other immunomodulating drugs
08.02.04  Expand sub section  Interferon Alfa to top
08.02.04  Expand sub section  Interferon beta
08.02.04  Expand sub section  Interferon gamma
08.02.04  Expand sub section  Aldesleukin
08.02.04  Expand sub section  BCG bladder instillation
08.02.04  Expand sub section  Dimethyl fumarate to top
08.02.04  Expand sub section  Fingolimod
08.02.04  Expand sub section  Glatiramer acetate
08.02.04  Expand sub section  Histamine
08.02.04  Expand sub section  Lenalidomide, pomalidomide, and thalidomide
08.02.04  Expand sub section  Mifamurtide to top
08.02.04  Expand sub section  Teriflunomide
08.03  Expand sub section  Sex hormones and hormone antagonists in malignant disease
08.03.01  Expand sub section  Oestrogens
08.03.02  Expand sub section  Progestogens
08.03.03  Expand sub section  Androgens to top
08.03.04  Expand sub section  Hormone antagonists
08.03.04.01  Expand sub section  Breast cancer
08.03.04.02  Expand sub section  Prostate cancer and gonadorelin analogues
08.03.04.02  Expand sub section  Gonadorelin analogues
08.03.04.02  Expand sub section  Anti-androgens to top
08.03.04.02  Expand sub section  Gonadotrophin-releasing hormone antagonists
08.03.04.03  Expand sub section  Somatostatin analogues
08.04  Expand sub section  Chimeric Antigen Receptor T-Cell (CAR-T) therapy
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Medicines which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

Amber 1

Amber Level 1- Specialist Recommendation
These medicines are considered suitable for GP prescribing following specialist recommendation.
 
There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
  

Amber 2

Amber Level 2- Specialist Initiation but no monitoring requirements
These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

Amber 3

Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

Red

Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

Grey

Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

Black

These drugs are not recommended for use within the Leeds Health Economy  

Multiple

Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

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